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MUHC-led study assesses use of high dose inhaler steroids as a preventative strategy for viral-induced childhood asthma

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Published: 6 May 2007

A new study has revealed that episodic use of twice-daily high-dose steroid inhaler at the onset of a cold can dramatically reduce the severity and duration of asthma attacks induced by colds in preschool-aged children.

A new study has revealed that episodic use of twice-daily high-dose steroid inhaler at the onset of a cold can dramatically reduce the severity and duration of asthma attacks induced by colds in preschool-aged children. The results of the study, led by researchers at the Montreal Children’s Hospital of the MUHC, were announced today at the Pediatric Academic Societies (PAS) International Conference in Toronto, Canada.

"Our results reveal that high doses of inhaled steroids can reduce by half the number of asthma attacks that require oral steroids," says Dr. Francine Ducharme, principal investigator of the study and leader of the Clinical Research on Childhood Asthma Group at the MUHC. "This is a great leap forward in the treatment of the most frequent type of asthma in preschoolers."

"Viral-induced asthma can be incredibly traumatic for both the child and family," says Dr. Ducharme, a professor in the department of pediatrics at McGill. "The common cold is one of the most frequent triggers of an asthma attack in both children and adults. Preschool–aged children have on average 8 to 12 colds per year, translating into about one asthma flare-up per month." More than five percent of preschool children make an emergency department visit each year for acute asthma in Quebec.

The cornerstone of asthma treatment is daily low doses of inhaled steroids, such as fluticasone. However, this has not been shown effective for children with cold-induced asthma. The MUHC study tested whether administering medication pre-emptively at the beginning of a cold could prevent the development of asthma attacks in children. We used 1500 micrograms of fluticasone per day, or approximately six times the standard pediatric dose. Their findings showed a 50 percent reduction in asthma attacks requiring oral steroids for children who were administered this higher dose and a 20 percent reduction in reported sick days.

"This is the first study to clearly show that the larger dose is effective," says Dr. Ducharme. "We also noted that children who took the high dosage of inhaled steroids grew at a slightly slower rate than those who took the placebo. For example, over the 10-month study the average growth of untreated children was about 6.5 cm and that of those on the high dose of steroids was 6.0 cm. The average weight gained for untreated children was about 2 kg, and those treated was 1.5." No other side effects were noted.

"The differences were slight, but significant," she adds. "It is possible that these children will make up this lower gain in weight and height over the coming years as they may no longer need to use an inhaler. Continued monitoring of these patients is necessary to clarify this issue."

The research, which was conducted at the MUHC, the Centre Hospitalier Universitaire de Sherbrooke, Hôpital Maisonneuve-Rosemont, Centre Hospitalier Universitaire de Ste-Justine, and the Clinique Pédiatrique la Courte Échelle involved 129 children with an average age of 2.5 years.

This study was funded through the Canadian Institutes of Health Research (formerly known as the Medical Research Council) supported by GlaxoSmithKline Canada.

The Montreal Children's Hospital is the pediatric teaching hospital of the McGill University Health Centre (MUHC). The institution is a leader in the care and treatment of sick infants, children and adolescents from across Quebec. The Montreal Children's Hospital provides a high level and broad scope of health care services, and provides ultra specialized care in many fields including: cardiology and cardiac surgery; neurology and neurosurgery, traumatology; genetic research; psychiatry and child development and musculoskeletal conditions, including orthopedics and rheumatology. Fully bilingual and multicultural, the institution respectfully serves an increasingly diverse community in more than 50 languages. www.thechildren.com

The Research Institute of the McGill University Health Centre (RI MUHC) is a world-renowned biomedical and health care hospital research centre. Located in Montreal, Quebec, the institute is the research arm of the MUHC, a university health centre affiliated with the Faculty of Medicine at McGill University. The institute supports over 500 researchers, nearly 1,000 graduate and post-doctoral students, and operates more than 300 laboratories devoted to a broad spectrum of fundamental and clinical research. The Research Institute operates at the forefront of knowledge, innovation and technology and is inextricably linked to the clinical programs of the MUHC, ensuring that patients benefit directly from the latest research-based knowledge. For further details visit: www.muhc.ca/research.

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